| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
4,970 |
4,557 |
$136K |
| D1999 |
|
5,733 |
5,163 |
$88K |
| D0330 |
Panoramic radiographic image |
2,082 |
1,865 |
$61K |
| D0120 |
Periodic oral evaluation - established patient |
4,265 |
3,966 |
$57K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,049 |
1,813 |
$42K |
| D0272 |
Bitewings - two radiographic images |
2,650 |
2,370 |
$38K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
850 |
463 |
$34K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,325 |
2,121 |
$33K |
| D1120 |
Prophylaxis - child |
1,034 |
935 |
$19K |
| D2160 |
|
374 |
229 |
$19K |
| D2140 |
|
166 |
102 |
$5K |
| D0140 |
Limited oral evaluation - problem focused |
74 |
63 |
$1K |